Absrtact
Background
The long-term clinical outcome of patients with previous coronary artery bypass grafting
(CABG), undergoing percutaneous coronary intervention (PCI) is not clear.
Methods
Observational, retrospective study of post-CABG patients, who underwent PCI in either
a graft or a native vessel.
Results
Out of 221 consecutive patients, those with PCI in both native vessel and graft (N = 16) and missing follow-up data (N = 15) were excluded. Out of the remaining 190 patients (age 67.9 ± 9.6 years; 90.0%
men), the graft-PCI group (N = 88) had more occluded native vessels (2.1 ± 0.8 vs 1.6 ± 0.8; P < 0.001), and fewer totally occluded grafts (0.55 ± 0.6 vs 0.75 ± 0.8; P = 0.05) compared with the native vessel-PCI group (N = 102). On follow-up (median duration 28 months), the incidence of major adverse
cardiac events (MACEs), cardiac death, and repeat revascularization was higher in
graft-PCI group compared with native vessel-PCI group (43.2% vs 19.6%, log-rank P < 0.001; 19.3% vs 6.9%, log-rank P = 0.008; and 23.9% vs 12.7%, log-rank P = 0.02, respectively). Graft-PCI was independently associated with higher risk for
major adverse cardiac events (hazard ratio [HR], 2.84; 95% confidence interval [CI],
1.45-5.57; P = 0.002), cardiac death (HR, 3.44; 95% CI, 1.16-10.22; P = 0.03) and repeat revascularization (HR, 2.41; 95% CI, 1.02-5.72; P = 0.046).
Conclusions
Post-CABG patients, undergoing graft compared with native vessel-PCI, have worse long-term
clinical outcome. Prospective studies are needed to elucidate the optimal revascularization
strategy for such patients.
Résumé
Introduction
Les conséquences cliniques à long terme chez les patients ayant eu un pontage aortocoronarien
(PAC) et subissant une intervention coronarienne percutanée (ICP) ne sont pas claires.
Méthodes
Une étude d'observation rétrospective de patients après un PAC qui subissaient une
ICP soit dans un greffon ou un vaisseau natif.
Résultats
Des 221 patients consécutifs, ont été exclus ceux ayant eu une ICP dans le vaisseau
natif ainsi que dans le greffon (N = 16) et ceux dont les données de suivi manquaient (N = 15). Des 190 patients restants (âgés de 67,9 ± 9,6 ans; 90,0 % d'hommes), le groupe
ayant subi une ICP dans le greffon (N = 88) avait plus de vaisseaux natifs obstrués (2,1 ± 0,8 vs 1,6 ± 0,8; P < 0,001) et moins de greffons totalement obstrués (0,55 ± 0,6 vs 0,75 ± 0,8; P = 0,05) que le groupe ayant eu une ICP dans le vaisseau natif (N = 102). Durant le suivi (durée médiane de 28 mois), l'incidence d'événements cardiaques
indésirables majeurs (ÉCIM), la mort cardiaque et la revascularisation répétée étaient
plus élevées dans le groupe ayant eu une ICP dans le greffon que dans le groupe ayant
eu une ICP dans le vaisseau natif (43,2 % vs 19,6 %, P < 0,001 selon le test logarithmique par rangs; 19,3 % vs 6,9 %, P = 0,008 selon le test logarithmique par rangs; et 23,9 % vs 12,7 %, P = 0,02 selon le test logarithmique par rangs, respectivement). L'ICP dans le greffon
était indépendamment associée à un risqué élevé d'événements cardiaques indésirables
majeurs (rapport de risque [RR], 2,84; intervalle de confiance [IC] de 95 %, 1,45-5,57;
P = 0,002), de mort cardiaque (RR, 3,44; IC de 95 %, 1,16-10,22; P = 0,03) et de revascularisation répétée (RR, 2,41; IC de 95 %, 1,02-5,72; P = 0,046).
Conclusions
Les patients ayant eu un PAC et subissant une ICP dans le greffon comparativement
à ceux subissant une ICP dans le vaisseau natif ont des conséquences cliniques à long
terme plus mauvaises. Des études prospectives sont nécessaires pour élucider la stratégie
de revascularisation optimale pour de tels patients.
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Article info
Publication history
Published online: October 24, 2011
Accepted:
August 7,
2011
Received:
June 24,
2011
Footnotes
See page 723 for disclosure information.
Identification
Copyright
© 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
